Systematic Review on Therapeutic Strategies to Minimize Corneal Stromal Scarring After Injury Objectives: To evaluate recent studies on available and experimental therapies in preventing or minimizing corneal stromal scarring after injury. Methods: We performed an Entrez PubMed literature search using keywords “cornea,” “scarring,” “haze,” “opacity,” “ulcer,” “treatments,” “therapies,” “treatment complications,” and “pathophysiology” resulting in 390 articles of which 12 were analyzed after filtering, based on English language and publication within 8 years, and curation for relevance by the authors. Results: The 12 articles selected included four randomized control trials (RCTs) (two were double-blinded placebo-controlled RCTs, one was a prospective partially masked RCT, and one was an open-label RCT), two retrospective observational studies, and six laboratory-based studies including two studies having in vivo and in vitro experiments, one was in vivo study, one was ex vivo study, and the last two were in vitro studies. The current mainstay for preventing or minimizing corneal scarring involves the use of topical corticosteroids and local application of mitomycin C. However, supportive evidence for their use in clinical practice from well-designed RCTs is lacking. Laboratory studies on topical rosiglitazone therapy, vitamin C prophylaxis, gene therapy, and stem cell therapy have shown promising results but have yet to be translated to clinical research. Conclusion: There is a need for more robust randomized controlled trials to support treatments using topical corticosteroids and mitomycin C. Furthermore, their clinical efficacy and safety profile should be compared with new treatments that have shown promising results in the laboratory setting. Ultimately, the goal should be to personalize cornea scarring treatment according to the most effective treatment for the specific underlying pathology.

Characteristics of Infectious Keratitis in Bandage Contact Lens Wear Patients Objective: The aim of this study was to determine the characteristics of infectious keratitis in patients wearing bandage contact lenses (BCLs). Methods: The BCL-related infectious keratitis cases were reviewed at the eye center of the Second Affiliated Hospital at the Zhejiang University School of Medicine from January 2015 to August 2018. Detailed information about the patients with infectious keratitis was collected, including the age, gender, clinical characteristics, culture results, and other measures. All the data analyses were performed using IBM SPSS Statistics for Windows version 24.0. Results: From January 2015 until August 2018, 6,385 eyes of 6,188 patients, including 3,410 males and 2,778 females, received BCLs at our hospital. The mean age of these patients was 48.10±20.81 years (range=15–78 years). The mean BCL wearing time was 18.98±23.72 days (range=1–58 days). Eight patients (0.13%) with infectious keratitis were identified, and the mean age of these patients was 54.33±28.14 years (range=16–75 years). Seven of the infectious keratitis patients were older than 50 years, and one patient was 16 years old. The infectious keratitis incidence rate of the older patients (≥50 years) was significantly higher than that of the young patients (<50 years) (χ2=9.647, P=0.002). There was a higher postkeratoplasty risk of BCL-related infectious keratitis than that in the corneal epithelial defect (χ2=21.371, P=0.000) and pterygium surgery (χ2=16.037, P=0.000) cases, but not in the corneal collagen cross-linking cases (χ2=1.792, P=0.181). The mean onset time of BCL-related infectious keratitis was 22.63±18.72 days (range=3–58 days) after wearing the BCLs. Among these 8 infected patients, 3 were noncompliant with their eye drop use and 2 extended their BCL wearing time past 30 days. Conclusion: Bandage CL–related infectious keratitis is more likely to occur in older patients. The most common risk factor for BCL-related infectious keratitis was postkeratoplasty use. Overall, appropriate indications, good compliance, and close follow-up attention are required for BCL wearers.

Evaluation of Long-Term Corneal Morphology After Photorefractive Keratectomy by In Vivo Confocal Microscopy and Specular Microscopy; 20-Year Follow-Up Purpose: To evaluate long-term corneal morphological changes after photorefractive keratectomy (PRK) using in vivo confocal microscopy (IVCM) and specular microscopy. Methods: This comparative case–control study included 16 eyes of 8 patients who underwent PRK for mild to moderate myopia 20 years ago and 30 eyes of 15 sex- and age-matched healthy controls. Corneal epithelial cells, sub-basal nerves, keratocytes (anterior, midstromal, and posterior), and endothelial cells were evaluated in both groups 10 and 20 years after surgery. Long-term visual outcomes were also recorded. Results: In vivo confocal microscopy examination revealed similar epithelial morphology, sub-basal nerve fiber morphology/density, mid/posterior stromal keratocyte density, and endothelial cell density between PRK patients and controls at their 10th and 20th year follow-up. Anterior stromal keratocyte density was lower at 10th year; however, it reached to control group value at 20th year follow-up. Extracellular matrix reflectivity was slightly higher, and there was a trace subepithelial corneal haze in PRK group (milder in 20th year than 10th year) compared with controls. At the 20th year, uncorrected distance visual acuity was 20/20 or more in 6 eyes (37.5%), 20/40 or more in 16 eyes (100%), and all eyes had corrected distance visual acuity of 20/20 or better (spherical equivalent −0.31±0.37 D). Conclusions: Photorefractive keratectomy in low to moderate myopia seems to be safe and effective method in the long term with preserving corneal morphology (including anterior stromal keratocyte and sub-basal nerve fiber density) and refractive outcomes as shown in this study. In appropriate patients, this method can be considered confidently.

Heritability of Corneal Curvature and Pentacam Topometric Indices: A Population-Based Study Purpose: To investigate familial aggregation of anterior and posterior corneal curvature, corneal astigmatism, and some corneal topometric indices using the Pentacam. Methods: Of 3,851 eligible individuals who resided in the selected areas, 2,779 met the conditions for analysis. However, analysis was limited to families whose Pentacam measures were available for at least 2 family members (father or mother and a child), resulting in 1,383 individuals in 382 families. All selected subjects underwent a set of examinations, including refraction, uncorrected and corrected visual acuity measurement, slitlamp biomicroscopy, and Pentacam imaging. Heritability estimation was used to calculate familial aggregation. Results: The results of our study showed a fairly high corneal curvature heritability. The heritability of K2 and K1 in the anterior surface was 58.61% (95% confidence interval [CI], 54.99–62.23) and 55.82% (95% CI, 52.66–58.98), respectively. The heritability of posterior corneal curvature was slightly higher than that of the anterior corneal curvature. The heritability of K2 and K1 in the posterior surface was 63.42% (95% CI, 60.07–66.77) and 59.67% (95% CI, 55.85–63.49), respectively. Investigation of the quantitative topographic corneal indices showed that index of surface variance (ISV), central keratoconus index, and index of vertical asymmetry (IVA) had the highest levels of heritability (81.2% [95% CI, 73.64–88.76], 75.21% [95% CI, 67.19–82.28], and 66.46% [95% CI, 61.99–70.93], respectively). However, keratometric power deviation and index of height asymmetry had the lowest heritability levels (7.48% 95% CI, [4.94–10.02] and 18.31% [95% CI, 16.07–20.55], respectively). Conclusion: The familial aggregation and relatively high heritability of the corneal curvature and some keratoconus-related indices, such as ISV and IVA, confirm a high correlation between these phenotypes and genetic factors and warrant further investigation of the genetic mechanisms in keratoconus.

Influence of Corneal Topographic Parameters in the Decentration of Orthokeratology Objective: To investigate the lens decentration (LD) of orthokeratology (ortho-k) and the association between pretreatment corneal topographic parameters and LD of the ortho-k. Methods: Fifty right eyes of 50 myopes wearing ortho-k lenses were included in the prospective study. Corneal topography was conducted pretreatment to get topographic corneal parameters, including flat-K (K1); steep-K (K2); corneal astigmatism (CA), CA at 0 to 3 mm (3 mm-CA), 3 to 5 mm (5 mm-CA), 5 to 7 mm (7 mm-CA); surface asymmetry index (SAI); surface regularity index; the curvature of best-fit sphere; the diameter of cornea (DC); the distance from the corneal center to the corneal vertex (CCCV); flat eccentricity (E1), steep eccentricity (E2), and E1/E2 (E ratio); and the corneal curvature differences between the nasal and temporal quadrants at 0 to 3 mm (3 mm-Knt), and the corneal curvature differences between the superior and inferior quadrants at 0 to 3 mm (3 mm-Ksi), 5 mm-Knt (at 3–5 mm), 5 mm-Ksi (at 3–5 mm), 7 mm-Knt (at 5–7 mm), and 7 mm-Ksi (at 5–7 mm). The relationship between these cornea topographic parameters and LD of the ortho-k was tested using stepwise multiple linear regression models. Results: The mean magnitude of LD was 0.51±0.23 mm (0.06–1.03 mm). According to the stepwise analysis, 4 factors were associated with the overall LD (P<0.01): SAI (β=0.252), CCCV (β=0.539), 5 mm-CA (β=−0.268), and 3 mm-Ksi (β=−0.374); 5 factors were associated with the horizontal LD (P<0.01): DC (β=0.205), CCCV (β=0.881), 3 mm-CA (β=−0.217), 5 mm-Knt (β=0.15), and 3 mm-Ksi (β=−0.18); and 3 factors were associated with the vertical LD (P<0.01): SAI (β=0.542), 5 mm-CA (β=−0.188), and 3 mm-Ksi (β=−0.213). Conclusion: Lens decentration is most common, but in most cases, the amount of LD is moderate and acceptable. The magnitude of LD can be predetermined by topographic corneal parameters. Surface asymmetry index, CCCV, 5 mm-Knt, and 3 mm-Ksi may be more preferable parameters in terms of the assessment of LD of ortho-k.

Repeatability of Noninvasive Keratograph 5M Measurements Associated With Contact Lens Wear Objective: To assess the intrarater repeatability of the measurements of tear meniscus height (TMH), noninvasive keratograph tear break-up time (NIKBUTs), and ocular redness measurements obtained with the Keratograph 5M (K5M) in a sample of soft silicone hydrogel contact lens (CL) wearers over 15 days. Methods: Prospective study over two consecutive weeks. Three measurements of TMH, NIKBUTs (NIKBUT first and NIKBUT average), and ocular redness were obtained in different sessions; the first day (baseline, at 8 hr of wear, and after lens removal) and the last day of wear—15th day (at 8 hr of wear and after lens removal). The repeatability of measurements were assessed by two intraclass correlation coefficient (ICC) forms; single measurement [ICC (2,1)] and multiple measurements (k=3) [ICC (2, k)]. Results: Sixty-four eyes were analyzed. The repeatability of baseline TMH [ICC (2,1) greater than 0.90; coefficient of repeatability (CR)=0.06 mm] and after and during CL wear [ICC (2,k) greater than 0.90; CR≤0.07 mm] were excellent. The repeatability of baseline NIKBUT average [ICC (2,k)=0.89 (0.82–0.93); CR=6.07 sec] was maintained after CL removal but was poorer during CL wear. The repeatability of baseline NIKBUT first [ICC (2,k) =0.80 (0.69–0.87); CR=8.74 sec] was maintained after CL removal and during CL wear at moderate–good level. Conclusions: Intrarater repeatability of TMH, NIKBUTs, and ocular redness performed by K5M after CL wear remains stable when three measurements are performed. However, intrarater repeatability during CL wear decreased only for NIKBUT average and was not affected by time of use (15 days).

Factors That Influence the Success of Contact Lens Fitting in Presbyopes: A Multicentric Survey Objectives: To evaluate the key factors behind successful and unsuccessful wear of contact lenses (CLs) for patients with presbyopia. Method: A multicenter survey was conducted using a questionnaire, in eight CL centers, among two groups of presbyopes: successful wearers (SWs), who were presbyopic and wearing CLs successfully, and unsuccessful wearers (UWs), who tried unsuccessfully to wear CLs to manage their presbyopia and had stopped wearing CLs. Results: A total of 237 completed questionnaires were returned; 178 from SWs and 59 from UWs. Successful wearers used CLs 5.8±1.5 days a week and additional reading spectacles were never used by half of the SWs. Among SWs, the most important reason to continue wearing CLs was convenience (61%), whereas among UWs, the most important reason to discontinue wearing CLs was poor vision (80%). A logistic regression analysis showed that the absence of astigmatism (P<0.05), a higher subjective satisfaction (P<0.05), a better subjective perceived vision at distance (P<0.01), and a lower subjective loss of visual contrast (P<0.05) were able to predict the success of CL use for presbyopia. Conclusions: This study explores the predictors for determining successful or unsuccessful CL wear in presbyopes. Among ophthalmic, demographic, lifestyle, and subjective variables, the latter seems to be of greater importance in determining the success of CL wear. Therefore, it is necessary that subjective variables are taken into account by the CL practitioner when approaching presbyopic CL fitting in practice.

Relationship Between Contact Lens and Pinguecula Purpose: To investigate the effects of contact lens (CL) on the frequency of pinguecula, and the relationship between dry eye disease and pinguecula. Methods: Two hundred and 33 cases of soft CL wearers and 230 age-matched nonwearers were enrolled in the study. Schirmer I test (ST) scores and tear break-up time (TBUT) were determined in all participants. A questionnaire including ocular surface disease index (OSDI), age, sex, and duration of CL wear was implemented to the participants before the examination. Results: The prevalence of pinguecula was 27.8% (n: 65) in the CL group and 26.5% (n: 61) in the control group. There was no significant difference between the groups (P=0.841). The prevalence of pinguecula increased with age in both groups. There was no significant difference in the prevalence of pinguecula when users were divided into three groups according to the duration of CL wear (P=0.575). The TBUT scores were lower, and the OSDI scores were higher in the CL group. The TBUT scores were lower in patients with pinguecula in both groups. The OSDI scores were higher in the CL group. There was no significant difference regarding the OSDI scores between patients with pinguecula and healthy participants in the CL group; however, OSDI scores were significantly higher in patients with pinguecula in control group. There were no significant differences in the ST scores between the groups, and between patients with pinguecula and healthy participants. Conclusion: This is the second study that evaluates the effects of soft CL wearing on pinguecula prevalence. We found that CL wearing does not affect the prevalence of pinguecula. Considering the OSDI scores in patients with pinguecula in the CL group, CL may suppress the irritant symptoms of pinguecula.

Clinical Features of Pingueculitis Revealed by Anterior Segment Optical Coherence Tomography Findings Purpose: To investigate clinical features and treatment outcomes of pingueculitis with morphological assessments using anterior segment optical coherence tomography (AS-OCT). Methods: In this retrospective observational study, we examined 22 eyes of 22 patients with pingueculitis. All patients were treated with the same 2-week course of prednisolone acetate 1% drops four times per day. The clinical parameters evaluated were surface dimensions determined by slitlamp biomicroscopy, cross-sectional dimensions determined by AS-OCT, and symptom scores determined by patient surveys. Pretreatment and 1-month posttreatment values were compared with Wilcoxon signed-rank tests. Patients were followed up to 1 year after treatment. Results: Twenty-two eyes from 22 patients (4 men and 18 women) with an average age of 37.7±8.8 (range, 27–57) years and an average duration of symptoms of 22 (range, 5–60) days were included. The average follow-up period was 14.7±0.8 (range, 12–22) months. Mean pretreatment horizontal length, vertical length, conjunctival thickness, and cross-sectional area were 2.4±0.69 mm, 2.0±0.6 mm, 1.82±0.60 μm, and 5.14±2.05 mm2, respectively. Mean posttreatment horizontal length, vertical length, conjunctival thickness, and area were 1.93±0.5 mm, 1.52±0.6 mm, 1.03±0.46 μm, and 2.33±0.83 mm2, respectively. Mean pretreatment and posttreatment dry eye symptom scores were 3.27±0.77 and 1.13±0.38, respectively. The median pretreatment and posttreatment changes were statistically significant by Wilcoxon signed-rank tests for horizontal length (P<0.001), vertical length (P<0.001), conjunctival thickness (P=0.003), cross-sectional area (P=0.003), and dry eye symptom scores (P<0.001). Conclusion: Anterior segment optical coherence tomography allows the quantification of differences in the pingueculitis measurements before and after treatment. In this retrospective study, a short course of topical steroids effectively treated the inflammation in a sustained manner. Anterior segment optical coherence tomography demonstrated significant reduction in the thickness and cross-sectional area of the pinguecula and a conversion back to a homogeneous conjunctival stroma.

Oxidative Stress and Genotoxicity in Pterygium: A Systemic Investigation Objectives: To perform a systemic investigation on oxidative stress and DNA damage in patients with primary pterygium. Methods: This prospective cross-sectional study included 32 patients with primary pterygium (60.1±2.0 years of age) and 33 age- and sex-matched (58.8±2.2 years of age) control subjects (P>0.05). A commercial kit was used for measuring serum total oxidant status (TOS) and total antioxidant status (TAS). The comet assay was performed after lymphocyte isolation from venous blood to quantitate DNA damage. Tail length (TL), tail intensity (TI), and tail moment (TM) were used for statistical analysis as parameters of DNA damage. Results: In the pterygium group, TOS and TAS were significantly higher when compared with those of the control group (P=0.019 and P=0.005, respectively). In terms of DNA damage, patients with pterygium had higher TL, TI, and TM than in the control subjects (P<0.0001 for all). Conclusions: Although current literature focuses on local factors in pterygium pathogenesis, patients with pterygium seem to have increased systemic oxidative status (and compensatory antioxidant response) and genotoxicity, which might create a predisposition for pterygium development.